Provider Demographics
NPI:1295025211
Name:BRADSHAW, HEATHER (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SUPERIOR ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5172
Mailing Address - Country:US
Mailing Address - Phone:503-979-6895
Mailing Address - Fax:
Practice Address - Street 1:358 SUPERIOR ST SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5172
Practice Address - Country:US
Practice Address - Phone:503-979-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2139101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional